If the patient has kidney disease or severe heart or liver disease, the patient should NOT use this preparation.
The patient should plan to start this bowel cleansing preparation the day before the scheduled procedure. Plan to be near a bathroom from the time the preparation is started until the end of the evening. The patient’s bowels may begin to move in about thirty to sixty (30–60) minutes. Feelings of nausea and bloating are common and resolve with time. An A+D type ointment applied to the rectal area can help with any irritation in that area. The goal is for the patient’s stool to be clear or light yellow water.
Two (2) bisacodyl tablets, which are available at any pharmacy. No prescription needed.
Polyethylene glycol 3350 powder, which is available at any pharmacy. No prescription needed. Also sold under the brand name MiraLAX.
Choice A: Buy one (1) 238-gram bottle of polyethylene glycol 3350 powder or
Choice B: Buy two (2) 119-gram bottles of polyethylene glycol 3350 powder Note: Some bottles of polyethylene glycol 3350 powder currently require a prescription. Be sure to get the non-prescription polyethylene glycol 3350,
Two (2) 32-ounce bottles of Gatorade G2 (64 ounces total). It must be Gatorade G2. Do not substitute. Gatorade G2 is the only acceptable drink for mixing with the bowel preparation. Refrigerate the Gatorade G2 until its cold before use.
A+D type ointment for rectal irritation.
One week prior to your procedure:
Do not take iron pills or medications that thin your blood (i.e., Coumadin, aspirin, ibuprofen naproxen, etc.) one week prior to your exam.
Five days prior to your procedure:
Please begin a restricted fiber diet which will result in less waste matter being discharged from the intestines, and smaller feces, thereby making the gastrointestinal tract easier to clean. Do not eat nuts, seeds, popcorn, corn, broccoli, cabbage, salads and onion. Discontinue high fiber foods, and fiber supplements like Metamucil and Konsyl.
The day before the procedure:
Drink only clear liquids for breakfast, lunch, and dinner. Solid foods, milk or milk products are not allowed. As a general rule, if you can see your fingers through a glass of liquid, that liquid is OK to drink. Red-colored liquids are not OK to drink because they can look like blood during the examination of your colon.
Clear liquids include:
- Ice Popsicle
- Clear broth or bouillon
- Kool-Aid or other fruit flavored drinks
- Carbonated and noncarbonated soft drinks
- Plain Jell-O (without added fruits or toppings)
- Coffee or tea (without milk or non-dairy creamer)
- Stained fruit juices without pulp (apple, white grape, lemonade)
The day before the procedure at Noon:
Take two 5mg Bisacodyl tablets with water. Do NOT chew or crush the tablet. No antacids should be taken within one hour of taking the bisacodyl delayed-release tablet. Wait for a bowel movement (or a maximum of six hours).
First Dose: The day before the procedure at 6:00 PM:
After the first bowel movement, or by 6:00 pm, for Choice A, mix one-half of a 238-gram (3/4 cup) of polyethylene glycol 3350 powder in 32 ounces of cold Gatorade G2. Drink this over one to two (1–2) hours. For Choice B, mix one (1) of the 119-gram bottles with 32 ounces of cold Gatorade G2. Drink this over one to two (1–2) hours.
TIP: For most patients, rapidly drinking a glassful is better than sipping an ounce or two at a time. Clear liquids are gulped faster and easier if they are ice cold, have little or no calories, and if they are sipped through a straw. Consider yourself a connoisseur and try pre-chilling your glass before using.
Take other clear liquids between doses of the bowel preparation. Drinking at least one (1) gallon of clear liquids during the evening will improve the quality of bowel cleansing.
Second Dose: Take the second dose the morning of your colonoscopy.
To determine when to start the morning preparation, allow at least four (4) hours for the preparation, and add the driving time to the endoscopy unit. The closer this second dose of the preparation is taken to the actual procedure, the better the preparation will be!
Mix the remaining one-half bottle of polyethylene glycol 3350 powder in another 32 ounces of cold Gatorade G2 or mix the second 119-gram bottle polyethylene glycol with 32 ounces of cold Gatorade G2. Drink this over one to two (1–2) hours.
Stop drinking liquids four (4) hours before the scheduled appointment time.
You must be accompanied by a friend or relative to drive you home.
CAUTION: Polyethylene Glycol 3350 solutions are contraindicated in patients with gastrointestinal obstruction, gastric retention, bowel perforation, toxic colitis, toxic megacolon, or ileus.
MiraLAX Polyethylene Glycol3350/Gatorade Preparation:
Its advantages are that it does not require a prescription, which makes it cheaper than all of the other prescription polyethylene glycol 3350 solutions. Furthermore, it has been proven safe in a wide range of patients including the elderly, diabetic, hypertensive, cardiac and renal as well as those with electrolyte imbalances. Patients add taste by mixing it with their favorite flavor of Gatorade G2®. This prep is only 1-quart when mixed, and is given in a split dose regimen, which is better tolerated by patients.
Prescription Polyethylene Glycol3350/Gatorade Preparations:
Prescription versions of polyethylene glycol 3350 solutions: TriLyte® in Lemon-Lime flavor; or NuLYTELY® packaged with 4-flavor packs including Cherry, Lemon-Lime, Orange and Pineapple.
MoviPrep®, GoLytely®, and CoLyte® solutions are prescription versions of polyethylene glycol 3350 solutions that contain sulfites. Sulfites tend to be less palatable and are therefore not preferred by patients.
CAUTION: Polyethylene glycol 3350 solutions are contraindicated in patients with gastrointestinal obstruction, gastric retention, bowel perforation, toxic colitis, toxic megacolon, or ileus.
OsmoPrep Phospho-soda Preparation:
OsmoPrep® has the advantage of coming in 32-flavorless pills that are to swallowed with water. Patients whom have had a bad experience with traditional polyethylene glycol 3350 solutions, or whom have anxiety about drinking noxious flavored solutions, might benefit from this alternative.
CAUTION: Patients should not take a phospho-soda preparations or OsmoPrep® if they are elderly, have congestive heart failure, or have high blood pressure and are taking antihypertensive medicine such as diuretics, ACE-Is, ARBs; or if they are taking NSAIDs such as Aspirin or Ibuprofen; as these patients would be at increased risk for kidney failure. There have been reports of acute phosphate nephropathy, a type of acute renal failure that is a rare but serious adverse event, associated with the use of oral sodium phosphates (OSP) for bowel cleansing. Notify your physician’s office immediately if you are taking any of these medicines or have any of these conditions and ask your doctor to verify which colon preparation he wants you to take.
Children under the age of 18 years; and patients with abdominal pain, nausea, or vomiting should not use phospho-soda preparations.
Suprep Sodium-potassium-magnesium SulfatePreparation:
Suprep® comes in two 6-ounce bottles that are each mixed with 10-ounces of water. Patients whom have had a bad experience with polyethylene glycol 3350 solutions, might benefit from this alternative.
Suprep® contains sulfites. Sulfites tend to be less palatable and are therefore not preferred by patients.
CAUTION: SUPREP® Bowel Prep Kit is an osmotic laxative indicated for cleansing of the colon as a preparation for colonoscopy in adults. Most common adverse reactions (>2%) are overall discomfort, abdominal distention, abdominal pain, nausea, vomiting and headache. Use is contraindicated in the following conditions: gastrointestinal (GI) obstruction, bowel perforation, toxic colitis and toxic megacolon, gastric retention, ileus, known allergies to components of the kit. Use caution when prescribing for patients with a history of seizures, arrhythmias, impaired gag reflex, regurgitation or aspiration, severe active ulcerative colitis, impaired renal function or patients taking medications that may affect renal function or electrolytes. Use can cause temporary elevations in uric acid. Uric acid fluctuations in patients with gout may precipitate an acute flare. Administration of osmotic laxative products may produce mucosal aphthous ulcerations, and there have been reports of more serious cases of ischemic colitis requiring hospitalization. Patients with impaired water handling who experience severe vomiting should be closely monitored including measurement of electrolytes. Advise all patients to hydrate adequately before, during, and after use. Each bottle must be diluted with water to a final volume of 16 ounces and ingestion of additional water as recommended is important to patient tolerance.
Children under the age of 18 years; and patients with gastrointestinal (GI) obstruction, bowel perforation, toxic colitis and toxic megacolon, gastric retention, ileus, and known allergies to components of the kit; should not use Suprep®.
Rectal Pulsed Irrigation
Rectal Pulsed Irrigation, also known as “colonics”, colon hydro therapy and colon irrigation. Colonics are often promoted by Natural Health Practitioners for colon detoxification. A 30-minute infusion of short pulses of warm tap water via the rectum through a rectal tube immediately before the colonoscopy, combined with magnesium citrate 10oz (any color but red) given the evening before the colonoscopy is a reasonable alternative to full-volume (4-liters) Polyethylene glycol 3350 solutions (PEG) in those individuals who cannot tolerate oral administration of PEG. The disadvantages to this colon preparation is that its time consuming, requires skilled nursing to administer, and as a result it is expensive to use.
CAUTION: In patients with congestive heart failure or impaired kidney function, there is a danger of a fluid overload in this procedure which could result in a cardiac arrest.
Are preoperative, perioperative, or peri-procedural antibiotics ever indicated for a colonoscopy procedure, EGD, or upper gastrointestinal endoscopy? The answer to this age old question is ever changing. For example, there are two past indications for which antibiotic prophylaxis is no longer relevant:
NON-INDICATION FOR ORTHOPEDIC PROSTHESIS
As of 2008, Antibiotic prophylaxis is not recommended for patients with orthopedic prosthesis who are undergoing GI endoscopic procedures.
NON-INDICATION FOR INFECTIVE ENDOCARDITIS
As of 2008-20012, Antibiotic prophylaxis solely to prevent infective endocarditis (IE) is no longer recommended before endoscopic procedures.
Antibiotic Prophylaxis for Upper Endoscopy, Esophagogastroduodenoscopy (EGD)
As of 2008-2012, there are only five known indications for antibiotic prophylaxis before an upper gastrointestinal endoscopy (EGD) procedure: